AUCTORES
Globalize your Research
Research Article | DOI: https://doi.org/10.31579/2642-9756/067
1*Nareman Elhamamy, Assistant Professor of Obstetrics and Gynecology, Faculty of Medicine, Tanta University. Egypt
*Corresponding Author: Nareman Elhamamy, Assistant Professor of Obstetrics and Gynecology, Faculty of Medicine, Tanta University. Egypt
Citation: Nareman Elhamamy, Ahmed M. Hagras (2021) Evaluation the Role Uterine Artery Doppler Indices in Prediction of Abnormal Uterine Bleeding in Intrauterine Contraceptive Device Users. J.Women Health Care and Issues 4(4); DOI: 10.31579/2642-9756/067
Copyright: © 2021 Nareman Elhamamy, this is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received: 24 May 2021 | Accepted: 31 May 2021 | Published: 08 June 2021
Keywords: intrauterine device ; pulsitility index ; resistant index
Contraceptive intrauterine device (IUD) is a successful method of contraception which has been used for more than 30 years.
The objectives of our study were to evaluate the correlation between abnormal uterine bleeding in IUD users and uterine artery Doppler [pulsitility index (PI); Resistant index (RI)] using transvaginal ultrasound and Doppler.
The study included 120 women from obstetrics and gynecology department Hospital. ,divided into three groups:
All fullfil the inclusion and exclusion criteria
The Results Of This Work Were:-
As regard to Doppler findings, it was noted that RI was significantly lower in group I in comparison to group II and group III and Pulsitility index (PI) followed the same pattern as RI.
We can conclude that detection of PI and RI in the uterine artery could be used to identify patients at risk of developing excessive bleeding after copper IUD insertion.
The Intrauterine Device (IUD) is the most widely used reversible form of contraception in the world [1].
AUB may be defined as any variation from the normal menstrual cycle, and includes changes in regularity and frequency of menses, in duration of flow, or in amount of blood loss [2].
Ultrasound is the imaging modality+ of choice for the female pelvis. It is widely available, has broad acceptance by patients and is relatively inexpensive. High-resolution imaging of transvaginal ultrasound provides high diagnostic accuracy for pelvic pathology [3].
Color Doppler ultrasonography to confirm the hypothesis that CIUD-induced bleeding is secondary to an increase in the uterine blood flow (as indicated by decreased PI and RI in uterine artery). Transvaginal color Doppler can be used to identify women at risk of developing abnormal uterine bleeding after CIUD insertion [4].
Aim of the Work
The present study aimed at using color Doppler ultrasonography in prediction of abnormal uterine bleeding in women after IUD insertion.
Patients And Methods
This study was a prospective clinical study including women who have been wearing an CIUCD, presenting to Obstetrics and Gynecology Department, from may 2018 to may 2019.
Study populations:
The study included 120 women. Sample size was calculated using Epi-Info® version 6.0 software, assuming a power of 80% and an -error of 0.5%.
Included women were divided into 3 groups:
Inclusion criteria:
Exclusion Criteria:
Methods:
History taking:
Clinical examination:
C- investigations:
-CBC.
-Random blood sugar.
Ultrasound examination:
All included women had a transvaginal ultrasound performed after instructing the patient to evacuate the bladder.
Measurements of dimension of the uterus (sagittal, transverse) sections were performed in addition to comment
on:
(a) Position.
(b) Endometrial thickness measured in sagittal section.
(c) Myometrial fibroids or adenomyosis.
(d) Endometrial polyps, thickness and irregularities.
(e) Adenexa and any abnormalities as ovarian cysts.
(f) Comment on IUCD: including site, displacement, partial expulsion, partial perforation, embedding:
I) the IUCD was detected by its echogenicity compared to the normal endometrium.
Blood flow indices of the uterine artery:
Transvaginal probe is placed in the anterior fornix , moved laterally to visualize the paracervical vascular plexus, -Color Doppler is turned on and the uterine artery is marked as it bends cranially into the uterine body.
Measurements are made at this point, before the uterine artery divides into the arcuate arteries. The same procedure is repeated on the contralateral side.
Note should be taken not to insulate the cervicovaginal artery (which passes from the cephalad to the cauda) or the arcuate arteries. Speeds of more than 50 cm / s are characteristic of the uterine arteries that may be affected.
Data were entered using Epi-Info version 6 and SPP for Windows version 8 [5].
Results
This prospective clinical study included 120 women who have been wearing anIUD for at least 6 months, presenting to Outpatient Gynecologic Clinic.
The study included 120 women, divided into three groups:
There was no substantial variation between the groups studied in terms of demographic evidence in our sample, there were no significant statistical variations between the groups studied in terms of age, parity and length of IUD usage Table 1.2.
There were no statistically meaningful variations between groups related to uterine proportions and endometrial thickness measurements by TVS. In women of group I, RI was slightly smaller than in women of groups II and III (p<0>
-PI was slightly smaller in Group I women than in Group II and Group III women (p<0>
Discussion
The objectives of our study were to evaluate the prediction between abnormal uterine bleeding in IUD users and uterine artery Doppler [pulsitility index (PI); Resistant index (RI)] using transvaginal ultrasound and Doppler.
In our study, there were no significant statistical differences between the studied groups concerning age, parity and duration of IUD use.
Our results are in agreement with study that During his work on levonorgestrel IUD, he reported that there is no connexion in both groups between endometrial thickness and days of bleeding or spotting [4, 6].
In our research, on the other hand, RI and PI were slightly lower in Group I women (women who use CIUD and complain about irregular uterine bleeding) than in Group II women and group III (control group) (p < 0>
Our results are correlated with Momtaz et al. (2014). -The PI and RI of the uterine arteries were measured in 68 women, including 44 who used intrauterine contraceptive devices and 24 control women who did not use a form of contraception. In women with CIUD-induced bleeding, both PI and RI were significantly lower than those who had used CIUD and did not think about irregular vaginal bleeding. Furthermore, there were no statistically relevant differences in PI and RI between women who used CIUD and women in c who did not complain of vaginal irregularity. [7].
Frajndlich et al. (2013) -Measured resistance and pulsatility in 101 women, 74 of whom used an intrauterine contraceptive device, and 27 of whom did not use a contraceptive process. Users of intrauterine contraceptives have been divided into three groups: those with frequent bleeding (n = 34); those with irregular uterine bleeding (n = 16); and those with excessive bleeding with a prostaglandin inhibitor (n = 24). Major Low resistance and pulsatility indices were recorded (8).
Hurskainen et al. -The PI of uterine arteries, arcuate arteries, and radial arteries is tested in 60 spontaneously menstruating women who complained of menorrhagia. The alkaline hematin mechanism has measured menstrual blood loss. A strong inverse correlation was observed between the uterine artery PI and the amount of menstrual blood loss, suggesting bleeding in individuals with lower uterine impedance. [9, 10].
Jamenez et al. (2018) reported that PI and RI variations were not statistically important between women with IUD-induced bleeding and women with regular menstrual IUD [11, 12, 17].
A foreign body reaction is caused in the adjacent endometrium by the insertion of an intrauterine implant into the uterine cavity. NO is present in the inflammatory response of the foreign body surrounding loosened implants for joint replacement. Thus, in the underlying tissue, it is likely that IUD still causes NO synthesis. A correlation between NO synthesis and prostaglandin synthesis is also present. NO interacts specifically with cyclo-oxygenase, which is responsible for the synthesis of prostaglandin and activates an injection. [13, 14 15].
Other potential pathways that clarify the relationship of uterine artery PI with menstrual blood loss are also accessible. A large rise in endothelial cell proliferation is seen by women with menorrhagia, suggesting disturbed angiogenesis. Such artery defects that occur from disrupted angiogenesis can also arise. In irregular vessels, weak haemostatic system contractibility and instability can cause menorrhagia and reduced impedance. [16, 18, 19].
In other study that. Three months later, on the corresponding period days, patients were checked again. Patients with dysmenorrhea consistent with IUD have improved pulsatility index. No major improvements in the blood supply of the uterine artery were found after the IUD was implanted during menstruation or in the midluteal process. There was, however, a drop in PI after IUD injection in patients with elevated IUD-related pain during menstruation. In all 5 patients, the decline in mean PI was present. They concluded that the copper IUD does not cause any significant improvements in uterine artery blood flow resistance, even in patients with increases during menstruation [20, 21].
Conclusion: -
The findings of our research support the theory that there is an improvement in uterine blood flow (indicated by diminished PI and RI in the uterine artery) in patients with CIUD-induced excessive uterine bleeding. The uterine artery Doppler can be used to classify patients at risk of experiencing severe bleeding following copper IUD.
Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.
Journal of Clinical Cardiology and Cardiovascular Intervention The submission and review process was adequate. However I think that the publication total value should have been enlightened in early fases. Thank you for all.
Journal of Women Health Care and Issues By the present mail, I want to say thank to you and tour colleagues for facilitating my published article. Specially thank you for the peer review process, support from the editorial office. I appreciate positively the quality of your journal.
Journal of Clinical Research and Reports I would be very delighted to submit my testimonial regarding the reviewer board and the editorial office. The reviewer board were accurate and helpful regarding any modifications for my manuscript. And the editorial office were very helpful and supportive in contacting and monitoring with any update and offering help. It was my pleasure to contribute with your promising Journal and I am looking forward for more collaboration.
We would like to thank the Journal of Thoracic Disease and Cardiothoracic Surgery because of the services they provided us for our articles. The peer-review process was done in a very excellent time manner, and the opinions of the reviewers helped us to improve our manuscript further. The editorial office had an outstanding correspondence with us and guided us in many ways. During a hard time of the pandemic that is affecting every one of us tremendously, the editorial office helped us make everything easier for publishing scientific work. Hope for a more scientific relationship with your Journal.
The peer-review process which consisted high quality queries on the paper. I did answer six reviewers’ questions and comments before the paper was accepted. The support from the editorial office is excellent.
Journal of Neuroscience and Neurological Surgery. I had the experience of publishing a research article recently. The whole process was simple from submission to publication. The reviewers made specific and valuable recommendations and corrections that improved the quality of my publication. I strongly recommend this Journal.
Dr. Katarzyna Byczkowska My testimonial covering: "The peer review process is quick and effective. The support from the editorial office is very professional and friendly. Quality of the Clinical Cardiology and Cardiovascular Interventions is scientific and publishes ground-breaking research on cardiology that is useful for other professionals in the field.
Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.
Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.
Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.
This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.
Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.
As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.
Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.
International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.
Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.
Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.
I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!
"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".
I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.
We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.
I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.
I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.
I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.
Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.
“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.
Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
